Hao R, Zhang W, Zhao K X
Clinical College of Opthalmology of Tianjin Medical University, Tianjin Eye Hospital and Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin 300020, China.
Zhonghua Yan Ke Za Zhi. 2019 Jan 11;55(1):20-24. doi: 10.3760/cma.j.issn.0412-4081.2019.01.005.
To observe the magnetic resonance imaging(MRI) changes of superior oblique muscle and to study the relationship between changes and clinical signs in superior oblique muscle palsy. Cross-sectional study. Data was collected from January 2014 to January 2016 in Tianjin Eye Hospital. Twenty-three(30 eyes) patients who were diagnosed with superior oblique palsy included 15 patients with congenital superior oblique palsy [9 males and 6 females aged (32±13) years (range, 12-53 years)] and 8 cases with acquired superior oblique palsy [3 males and 5 females aged (36±15) years(range, 17-62 years)]. Twenty normal volunteers [11 males and 9 females aged (35±13) years (range, 15-60 years)] were also observed. Coronal MRI was used to detect superior oblique muscle morphological changes, as well as the maximum cross-sectional area and volume changes. The relationship between the morphological changes and vertical deviation and cyclotorsion in the primary gaze was analyzed. Rank sum test, -test and Person correlation analysis were used for statistical analysis. Two morphological changes were obtained using MRI in superior oblique muscle palsy, including round (19 eyes) and oval changes (11 eyes). The maximum cross-sectional area in eyes with the palsied superior oblique muscle [round, (10.38±1.76) mm(2); oval, (11.16±2.02) mm(2)] was significantly smaller than fellow eyes [(14.16±1.88) mm(2); =6.208, 5.178, both 0.001] and eyes with normal superior oblique muscle [(15.40±1.71) mm(2); =8.215, 6.330, both 0.001], and the volume changes [round, (104.92±13.36) mm(3); oval, (110.43±16.11) mm(3)] were also significantly different from fellow eyes [(254.57±20.15) mm(3); =7.511, 5.396, both 0.001] and eyes with normal superior oblique muscle [(258.04±16.36) mm(3); =10.040, 6.936, both 0.001]. There was no significant difference in vertical deviation between round and oval superior oblique muscle palsies (0.05). The cyclotorsion effect of the round change in superior oblique muscle palsy was significantly less than that of the oval change (5.47°±1.05° . 7.36°±0.97°, 3.083, 0.005). The correlation of the volume changes with vertical deviation angle in the primary gaze was not significantly different (round and oval, both 0.05), but there was a correlation between the morphological changes and cyclotorsion strabismus (0.631, 0.004; 0.801, 0.003). In the patients with superior oblique palsy, MRI scans shows that the maximum cross-sectional area decreased and the volume was smaller, which indicated superior oblique muscle atrophy. Deformation of superior oblique muscle do not significantly affect the vertical deviation, but is in correlation with cyclodeviation. .
观察上斜肌的磁共振成像（MRI）变化，并研究上斜肌麻痹时这些变化与临床体征之间的关系。横断面研究。数据收集于2014年1月至2016年1月期间的天津眼科医院。23例（30只眼）被诊断为上斜肌麻痹的患者，其中包括15例先天性上斜肌麻痹患者[男9例，女6例，年龄（32±13）岁（范围12 - 53岁）]和8例后天性上斜肌麻痹患者[男3例，女5例，年龄（36±15）岁（范围17 - 62岁）]。还观察了20名正常志愿者[男11例，女9例，年龄（35±13）岁（范围15 - 60岁）]。采用冠状面MRI检测上斜肌形态变化以及最大横截面积和体积变化。分析形态学变化与第一眼位垂直偏斜和旋转斜视之间的关系。采用秩和检验、t检验和Person相关分析进行统计学分析。在上斜肌麻痹患者中通过MRI获得两种形态学变化，包括圆形（19只眼）和椭圆形变化（11只眼）。麻痹侧上斜肌眼的最大横截面积[圆形，（10.38±1.76）mm²；椭圆形，（11.16±2.02）mm²]明显小于健侧眼[（14.16±1.88）mm²；t = 6.208，5.178，P均＜0.001]和上斜肌正常眼[（15.40±1.71）mm²；t = 8.215，6.330，P均＜0.001]，体积变化[圆形，（104.92±13.36）mm³；椭圆形，（110.43±16.11）mm³]也与健侧眼[（254.57±20.15）mm³；t = 7.511，5.396，P均＜0.001]和上斜肌正常眼[（258.04±16.36）mm³；t = 10.040，6.936，P均＜0.001]有显著差异。圆形和椭圆形上斜肌麻痹之间的垂直偏斜无显著差异（P＞0.05）。上斜肌麻痹中圆形变化的旋转斜视效应明显小于椭圆形变化（5.47°±1.05° 对 7.36°±0.97°，t = 3.083，P = 0.005）。第一眼位时体积变化与垂直偏斜角度的相关性无显著差异（圆形和椭圆形，P均＞0.05），但形态学变化与旋转斜视存在相关性（r = 0.631，P = 0.004；r = 0.801，P = 0.003）。在上斜肌麻痹患者中，MRI扫描显示最大横截面积减小且体积变小，提示上斜肌萎缩。上斜肌变形对垂直偏斜影响不显著，但与旋转偏斜相关。
